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    Original Investigation
    Health Policy
    April 30, 2020

    Utilization and Cost of an Employer-Sponsored Comprehensive Primary Care Delivery Model

    Author Affiliations
    • 1Center for Primary Care, Harvard Medical School, Boston, Massachusetts
    • 2School of Public Health, Imperial College, London, United Kingdom
    • 3Research and Analytics, Collective Health, San Francisco, California
    • 4Enterprise Analytics, One Medical, San Francisco, California
    • 5Data Science, One Medical, San Francisco, California
    • 6Employee Benefits, SpaceX, Hawthorne, California
    JAMA Netw Open. 2020;3(4):e203803. doi:10.1001/jamanetworkopen.2020.3803
    Key Points español 中文 (chinese)

    Question  What are the utilization rates and costs of service of a comprehensive primary care model that incorporates employer-sponsored on-site, near-site, and virtual primary care?

    Findings  In this cohort study of 23 518 commercially insured employees, the employer-sponsored services cost a mean (SD) of $87 ($32) per member per month after accounting for infrastructure and service costs, with members using the model clinics for most of their primary care having higher primary care costs but lower total health care costs in a matched cohort analysis controlling for demographics, diagnoses, and risk.

    Meaning  The findings suggest that lower total health care costs per person and higher primary care costs may be associated with preferential use by lower-risk persons and/or with the use of comprehensive primary care.


    Importance  Primary care is increasingly delivered at or near workplaces, yet utilization and cost of employer-sponsored primary care services remain unknown.

    Objective  To compare the health care utilization and cost of an employer-sponsored on-site, near-site, and virtual comprehensive primary care service delivery model with those of traditional community-based primary care.

    Design, Setting, and Participants  This population-based cohort study of 23 518 commercially insured employees and dependents of an engineering and manufacturing firm headquartered in southern California was performed from January 1, 2016, to July 1, 2019. A subset of the population with most (≥50%) primary care visits through employer-sponsored on-site, near-site, or virtual care clinics was matched to a subset not having most such visits through the employer-sponsored clinics using propensity score matching (n = 1983 each). In sensitivity analyses, employees were matched to dependents at neighboring firms that lacked access to the employer-sponsored primary care delivery model (additional n = 1680).

    Exposures  Integrated primary care, mental health, and physical therapy delivered through on-site, near-site, and virtual clinics.

    Main Outcomes and Measures  Utilization (inpatient, outpatient, emergency department, pharmaceutical, radiology, and laboratory visits per 1000 member-months) and spending (2019 costs per member per month in US dollars) by service type.

    Results  A total of 23 518 individuals (mean [SD] age, 27 [15] years; 14 604 [62.1%] male) were included in the full population sample and had been enrolled in the employer-sponsored health plan for a mean of 29 months (interquartile range, 14-48 months). Of eligible members, 5292 (22.5%) used the employer-sponsored services, with 2305 (9.8%) using them for most of their primary care. The mean (SD) cost of employer-sponsored service delivery was $87 ($32) per member month. Among the matched populations (mean [SD] age, 31 [11] years; 3349 [84.5%] male) of primary users vs control individuals, total spending was 45% lower per member per month (95% CI, 35%-55%; cost difference, −$167 per member per month; 95% CI, −$204 to −$130; P < .001) among users after adjustment. The lower spending was associated with lower spending on non–primary care services, such as emergency department (−33%; 95% CI, −44% to −22%) and hospital visits (−16%; 95% CI, −22% to −10%), despite higher spending on primary care (109%; 95% CI, 102%-116%) and mental health (20%; 95% CI, 13%-27%).

    Conclusions and Relevance  The findings suggest that individuals who used the models’ services for most of their primary care had lower total spending despite higher primary care spending, which may be associated with self-selection of lower-risk persons to the employer-sponsored services and/or with the use of comprehensive primary care.